Residents of New Madrid County and Missouri’s Bootheel face many hurdles to good health. Ranking 113 out of 115 counties (plus the City of St. Louis) in its overall health outcomes, one in three New Madrid County residents is obese. And while the rates for adults are high, there is a clear imperative to help the littlest residents of the Bootheel, too. Among Missouri’s low-income children aged 2-4 years old, over 10-15% are obese. Obesity has been long associated with many poor health outcomes and chronic diseases, including heart disease, diabetes, and some cancers, among others.

But the New Madrid Health Department has been quietly working to change these statistics. Funded for five years through the Missouri Foundation for Health, the New Madrid County Healthy and Active Communities project has been linking programs, education, outreach and partnerships to improve the eating and physical activity habits of its residents.

Pat Maltbia, who formerly led the project, said, “Our county is one of the lowest as far as health [outcomes]. We have a lot of people with high blood pressure, heart disease and diabetes. The simple thing about it is if you catch it in time, it doesn’t have to blow into something bigger.”

When talking with Maltbia about the project, its scope and multi-pronged are readily apparent. In order to make the community healthier, opportunities had to be created, and everyone had to be involved. She recalls, “You want people to live a healthier lifestyle and they don’t have the money or access to do that. In our town, we didn’t have a fitness center. There are transportation problems with going out of town; you have to pay membership fees. We needed something in the community that serves the community. When you ask people to live healthy, you have to make a way for them to do that.”

And so began the work of building in programs and services to fill the gaps in New Madrid County. Through their grant funding, Maltbia was able to create a faith-based program in five African American churches, a physical and nutrition program in three elementary schools, a free fitness center, and five walking trails. The O’Bannon Fitness Center, now in Howardville, is housed in a former community center donated by the city. It is open to the whole community and offers classes and programs for all ages. The five walking trails, located all around the county, are integrated into the faith-based programming, including the popular, “Walking to Jerusalem” project.

Gaining support in the community, though, didn’t happen overnight. “There is so much to cover,” says Maltbia. “I do research and this is what gets the businesses and companies and schools on board [to support the projects]. When I show them if you have more recess time, this is the difference [seen] in the child that had more activity and the child who didn’t. You have to show statistics, but do it in a way not to bore them.”

She cites examples of changing the hearts and minds of community members by redoing church recipes which typically called for high amounts of trans-fats, salt and other nutritional no-no’s. “We do a healthy meal, and [we show them] it tastes good.”

Maltbia also says to support their work, the health department sent out letters to businesses and local restaurants, encouraging them to support these healthy and active programs and try to implement their own methods of nudging employees and customers toward healthy habits. To date, the health curriculum program has been implemented at two local companies, the power and aluminum plants.

Again and again, Maltbia is clear that leveraging partnerships in the communities was critical to the program’s success.

“We provided the health educators in the churches, schools and fitness center,” she says. But education was just part of it. Programming, outreach and overall sustainability, rested in the hands of many community members and organizations. For instance, Maltbia says, the health department developed policies for the programs and had memoranda of understanding written between the churches, schools, cities and counties served. Incentives to keep program participants motivated were purchased, but the walks and events were staffed by partners.

Along the way, though, Maltbia acknowledges that there were challenges. “Our first two years were experimental and we learned what works. That’s what it takes. And you pass that information along to the next person so they will also know what works.”

What were some of the specific challenges? Maltbia recalls that, “It was hard to get people. We have a health department here, but you’d be surprised how many people don’t come here and ask questions. You get in a rut. You have to prove it to them. But once it’s set up, it’s rewarding, and [people are] excited to do something about it. And it didn’t cost them anything. Basic health costs are expensive if you don’t have health care, and then if you do, you can’t afford to pay to go to a facility.”

She notes that working with the church community was a natural progression. “People trust the church. If the church is on board, most people will follow. [Because of the faith based program] we pulled people in who probably never would have thought about eating right and exercising. They thought it would take a lot of money. [But] we taught chair exercises, aerobics [that] they can do at home and they don’t have to pay.”

Likewise, Maltbia says they were able to expand their reach and bring in more residents by securing the community center that now houses the fitness center. She says that while working through churches has been very successful, she’s also aware that some people may not be as comfortable. “The last three years that we had the community center, people felt more comfortable about coming. When you open up a facility within the whole community, everyone knows they’re welcome to come in. It covers more people, some people who don’t even belong to a church.”

Outcomes

“People learn that it works. [They’re] changing their lifestyle and their eating habits,” says Maltbia. Since starting, the program has been implemented at two local companies as well. “It stretches out and people have to see that it works,” she continues. “Missouri is the show me state. Our objective is if everyone sees in every avenue of everyday life that everyone’s trying to get healthy, it sinks in.”